Box Request form

With an understanding of Betty's personal experience, identifying what gave her comfort and brought back her sense of beauty, our post-mastectomy care kit is carefully crafted to provide the same comfort during the healing process for women facing similar circumstances.

If you live in Kentucky* and would like to personally receive one of our boxes, please use the recipient form button below to submit your information.

Please do not fill out a form on someone else’s behalf; we must have a completed form directly from the recipient.

Please note: While our free service is available for Kentucky residents only, a box may be purchased through our Donate a Box page for out-of-state residents.